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Adrenal Mass

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3781. Correlation between radiologic and pathologic dimensions of adrenal masses. (Abstract)

Correlation between radiologic and pathologic dimensions of adrenal masses. The size of adrenal tumors has been shown to be a good predictor of malignancy. There is still some controversy about the concordance between radiologic and real pathologic measurements. The aim of this study is to determine the correlation between direct and corrected radiologic computed tomography scan dimensions and the measurements of the resected specimen. A total of 41 adrenal tumors were included. Direct (...) variables showed r = 0.82 (p < 0.0001) when direct and pathologic measurements were compared and r = 0.83 (p < 0.0001) when the corrected values were compared with the real dimensions. In this study, we demonstrate good correlation between radiologic and pathologic measurements of adrenal tumors. The Linos formula turned out to be significantly more accurate than direct radiologic measurements when means of the groups were compared, whereas when individual correlations were determined the two were

2004 World Journal of Surgery

3782. The clinical conundrum of corticotropin-independent autonomous cortisol secretion in patients with bilateral adrenal masses. (Abstract)

The clinical conundrum of corticotropin-independent autonomous cortisol secretion in patients with bilateral adrenal masses. Management of patients with bilateral adrenal masses and corticotropin (ACTH)-independent Cushing syndrome (CS) or subclinical CS is problematic. We report our experience with adrenal venous sampling (AVS) in the evaluation of 10 patients with bilateral masses who had ACTH-independent CS or subclinical CS.Ten patients (9 women, 1 man, mean age 56.4 years) with bilateral (...) adrenal masses and ACTH-independent CS (n=3) or subclinical CS (n=7) underwent AVS. Autonomous cortisol secretion was documented in all cases with suppressed serum ACTH concentrations and lack of cortisol suppression with dexamethasone administration. Adrenal venous sampling was performed on the second day of dexamethasone administration. Cortisol and epinephrine levels were measured from each adrenal vein (AV) and from a peripheral vein (PV).Mean (+/-SD) maximal diameter of the adrenal masses

2008 World Journal of Surgery

3783. Adrenal masses: characterization with in vivo proton MR spectroscopy--initial experience. (Abstract)

Adrenal masses: characterization with in vivo proton MR spectroscopy--initial experience. To prospectively determine the accuracy of in vivo proton ((1)H) magnetic resonance (MR) spectroscopy in distinguishing adrenal adenomas, pheochromocytomas, adrenocortical carcinomas, and metastases, with histologic or computed tomographic findings and follow-up data as the reference standards.This study was approved by the institutional ethics committee, and informed consent was obtained. Sixty (...) were measured. Metabolite ratios (choline-creatine, choline-lipid, lipid-creatine, and 4.0-4.3 ppm/creatine) and cutoff values (obtained by using receiver operating characteristic analyses) were obtained and compared for each type of adrenal mass, which was identified previously on the basis of clinical, hormonal, and pathologic evidence. Results were evaluated with chi(2) and Student t tests. Significance was inferred at P < .05.Cutoff values of 1.20 for the choline-creatine ratio (92% sensitivity

2007 Radiology

3784. Development and performance evaluation of a tandem mass spectrometry assay for 4 adrenal steroids. Full Text available with Trip Pro

Development and performance evaluation of a tandem mass spectrometry assay for 4 adrenal steroids. Congenital adrenal hyperplasia is a group of autosomal recessive disorders caused by a deficiency of 1 of 4 enzymes required for the synthesis of glucocorticoids, mineralocorticoids, and sex hormones. Analysis of 11-deoxycortisol (11DC), 17-hydroxyprogesterone (17OHP), 17-hydroxypregnenolone (17OHPr), and pregnenolone (Pr) in blood allows detection of these enzyme defects.The steroids were (...) extracted from 200 microL of serum or plasma by solid-phase extraction, derivatized to form oximes, and extracted again with methyl t-butyl ether. Instrumental analysis was performed on an API 4000 tandem mass spectrometer with electrospray ionization in positive mode and multiple reaction-monitoring acquisition.The limits of detection were 0.025 microg/L for 11DC, 17OHP, and Pr and 0.10 microg/L for 17OHPr. The method was linear to 100 microg/L for 11DC, 17OHP, and Pr, respectively, and to 40 microg/L

2006 Clinical Chemistry

3785. Adrenocortical carcinoma arising from a long-standing adrenal mass. Full Text available with Trip Pro

Adrenocortical carcinoma arising from a long-standing adrenal mass. Adrenocortical carcinoma is a rare tumor with a dismal prognosis. In stark contrast, benign incidental adrenal lesions are detected commonly on routine abdominal imaging. We report a case of a 74-year-old man with a history of germ cell testicular carcinoma who presented with a 4.8-cm left adrenal lesion. The lesion remained stable for 8 years, at which time the patient became symptomatic from an excess of cortisol hormone

2005 Mayo Clinic Proceedings

3786. Chemical shift MR imaging of hyperattenuating (>10 HU) adrenal masses: does it still have a role? (Abstract)

Chemical shift MR imaging of hyperattenuating (>10 HU) adrenal masses: does it still have a role? To evaluate chemical shift magnetic resonance (MR) imaging for the characterization of hyperattenuating adrenal masses.Adrenal MR images obtained from January 1998 to February 2003 were reviewed. Patients were excluded if they did not undergo unenhanced computed tomography or did not have an adrenal mass with attenuation higher than 10 HU, adequate follow-up, or pathologic diagnosis for use (...) as a reference standard. A diagnosis of adenoma required at least 24 weeks of stability on images. Thirty-eight masses in 36 patients were identified (27 adenomas, nine metastases, one adrenocortical oncocytoma, and one pheochromocytoma). Signal intensity (SI) decrease between in-phase and opposed-phase MR images was measured for the entire mass and normalized to the renal parenchymal SI. In 21 of 36 (58%) patients, dual-echo single-breath-hold MR imaging was used to eliminate misregistration.The attenuation

2004 Radiology

3787. Distinguishing benign from malignant adrenal masses: multi-detector row CT protocol with 10-minute delay. (Abstract)

Distinguishing benign from malignant adrenal masses: multi-detector row CT protocol with 10-minute delay. To retrospectively evaluate the accuracy of precontrast attenuation, relative percentage washout (RPW), and absolute percentage washout (APW) in distinguishing benign from malignant adrenal masses at multi-detector row computed tomography (CT).This HIPAA-compliant retrospective study had institutional review board approval; the need for informed consent was waived. One hundred twenty-two (...) adrenal masses were evaluated in 99 patients (51 men, 48 women; age range, 37-86 years) who had undergone CT performed according to the study protocol and who either were given a pathologic diagnosis or underwent follow-up imaging. Unenhanced images were obtained before administration of 120 mL of an intravenous contrast agent with a 75-second scan delay. Delayed images were obtained after 10 minutes. RPW and APW were computed. Receiver operating characteristic (ROC) analysis was performed to compare

2006 Radiology

3788. Comparison of delayed enhanced CT and chemical shift MR for evaluating hyperattenuating incidental adrenal masses. (Abstract)

Comparison of delayed enhanced CT and chemical shift MR for evaluating hyperattenuating incidental adrenal masses. To retrospectively compare the accuracy of delayed enhanced computed tomography (CT) and chemical shift magnetic resonance (MR) imaging for characterizing hyperattenuating adrenal masses at CT, with either follow-up imaging or pathologic review as the reference standard.The institutional review board approved this retrospective study with a waiver of patient informed consent. Forty (...) -three hyperattenuating adrenal masses (>10 HU) on unenhanced CT images were found in 34 patients (23 men and 11 women; mean age, 52.7 years) by reviewing radiologic reports. These lesions were retrospectively analyzed with delayed enhanced CT and chemical shift MR. The diagnostic accuracy of CT by using absolute percentage loss of enhancement (PLE) and relative PLE and of chemical shift MR by using adrenal-to-spleen ratio (ASR) or signal intensity index (SII) were obtained to determine which

2007 Radiology

3789. Clinically Inapparent Bilateral Adrenal Masses Due to Histoplasmosis. (Abstract)

Clinically Inapparent Bilateral Adrenal Masses Due to Histoplasmosis. Detection of bilateral adrenal masses in any patient often presents a management dilemma. Despite extensive imaging, positron emission tomography (PET) scanning, and fine needle aspiration biopsy (FNAB), a definite diagnosis may not be reached. We report an unusual case of bilateral adrenal mass diagnosed as histoplasmosis postoperatively and managed successfully by laparoscopy. Focus is placed on the role of laparoscopic

2008 European Urology

3790. Diagnostic value of various biochemical parameters for the diagnosis of pheochromocytoma in patients with adrenal mass. Full Text available with Trip Pro

Diagnostic value of various biochemical parameters for the diagnosis of pheochromocytoma in patients with adrenal mass. Pheochromocytomas are neoplasms generally characterized by the autonomous production of catecholamines. This study compared various biochemical parameters for the diagnosis of adrenal pheochromocytoma in patients with adrenal mass.One hundred and fifty subjects were studied, including 24 histologically proven pheochromocytomas, 17 aldosterone-secreting and 21 cortisol (...) -secreting adrenal adenomas and 30 nonfunctioning adrenal masses, 16 patients with essential hypertension and 42 healthy normotensive volunteers. Spontaneous blood samples and 24-h urine samples were collected prospectively.Plasma and urinary epinephrine and norepinephrine levels were measured by high performance liquid chromatography, whereas plasma and urinary metanephrine and normetanephrine levels were determined by radioimmunoassay (RIA). Putative ratio thresholds were calculated by receiver

2006 European Journal of Endocrinology

3791. Laparoscopic adrenalectomy for adrenal masses: does size matter? (Abstract)

Laparoscopic adrenalectomy for adrenal masses: does size matter? To examine the impact of adrenal tumor size on perioperative morbidity and postoperative outcomes in patients undergoing laparoscopic adrenalectomy.A total of 227 laparoscopic adrenalectomies were divided in three groups according to size as estimated by pathologic specimen maximum diameter: less than 6 cm (group 1, n = 140), between 6 and 7.9 cm (group 2, n = 47), and equal to or larger than 8 cm (group 3, n = 40). We (...) , respectively. Average hospital stay was 2 days (range, 2 to 3 days), 2 days (range, 2 to 3 days), and 3 days (range, 2 to 4 days), respectively, for groups 1, 2, and 3. Operative time, average blood loss, and mean hospital stay were significantly higher (P adrenal masses (8 cm or greater) is associated with significantly longer operative time, increased blood loss, and longer hospital stay, without affecting perioperative

2008 Urology

3792. Comparison of active renin concentration and plasma renin activity for the diagnosis of primary hyperaldosteronism in patients with an adrenal mass. (Abstract)

Comparison of active renin concentration and plasma renin activity for the diagnosis of primary hyperaldosteronism in patients with an adrenal mass. Plasma aldosterone concentration (PAC) to plasma renin activity (PRA) ratio is an established screening test for primary hyperaldosteronism. Due to the increased recognition of adrenal incidentalomas, reliable parameters are required. Determination of active renin concentration (ARC) in contrast to PRA offers advantages with regard to processing (...) and standardization. The present study compared PRA and ARC under random conditions to establish thresholds for the diagnosis of primary hyperaldosteronism.Fifty patients with various adrenal tumors, including ten patients with aldosterone-secreting adrenal adenomas, as well as ten hypertensive patients and 23 normotensive volunteers were studied. PAC and PRA were measured by radioimmunoassay. ARC was determined by an immunoluminometric assay.Receiver operating curve (ROC) analysis suggested a PAC to ARC ratio

2004 European journal of endocrinology / European Federation of Endocrine Societies Controlled trial quality: uncertain

3793. Surgical management of large adrenal masses with or without thrombus extending into the inferior vena cava. (Abstract)

Surgical management of large adrenal masses with or without thrombus extending into the inferior vena cava. Surgical extirpation is the only curative treatment for large adrenal masses with or without thrombus extending into the inferior vena cava. However, occasionally complex surgical techniques are required, including venovenous bypass or cardiopulmonary bypass (CPB). Additionally, applying techniques used for organ transplantation can provide better exposure with less blood loss to allow (...) milking of the thrombus downward, limiting the need for bypass.Ten patients underwent surgery for large adrenal masses using these techniques. Five patients had thrombi extending into the inferior vena cava, causing Budd-Chiari syndrome in 1. A classification system was proposed for adrenal masses associated with venous thrombus.Median patient age was 51 years. Surgery was completed successfully in all patients. Only 1 patient with an adherent intra-atrial thrombus required CPB. Mean blood loss

2004 Journal of Urology

3794. Endoscopic ultrasound-guided fine-needle aspiration of left adrenal gland masses. (Abstract)

Endoscopic ultrasound-guided fine-needle aspiration of left adrenal gland masses. Although the left adrenal gland is readily visible by endoscopic ultrasound (EUS), there are few published data on the utility of EUS-guided fine-needle aspiration (EUS-FNA) of this site. The aim of this study was to report our experience of EUS-FNA of left adrenal gland masses.In this retrospective case series, we reviewed our EUS and cytology databases to identify consecutive patients who underwent EUS-FNA (...) of the left adrenal gland between January 1997 and January 2004. Medical records were reviewed and the results of EUS examinations and cytological investigations were abstracted.Our searches resulted in the identification of a series of 38 consecutive patients who underwent EUS for the evaluation of a lung mass (n = 14), a pancreatic mass (n = 14), obstructive jaundice (n = 1), dysphagia (n = 2), an ampullary adenoma (n = 1), celiac block (n = 1), or a left adrenal gland mass (n = 5). The mean maximal

2007 Endoscopy

3795. Isolated adrenal mass in patients with a history of cancer: remember pheochromocytoma. (Abstract)

Isolated adrenal mass in patients with a history of cancer: remember pheochromocytoma. In a patient with a history of cancer, an isolated adrenal mass is usually thought to be a metastasis. Although a biochemical work-up to rule out pheochromocytoma is recommended, some question its practicality. This study was undertaken to determine the incidence of functional adrenal lesions in patients with a history of cancer and examine predictive factors for the type of lesion.At a single institution, 33 (...) patients with an isolated adrenal mass and a history of cancer underwent surgical treatment. Patients' records were retrospectively analyzed for type of adrenal lesion and other diagnostic parameters.There were 20 males and 13 females with a mean age of 58+/-2 years. Of these, 20 (61%) had adrenal metastases, 8 (24%) had pheochromocytomas, and 5 (15%) had adrenal adenomas. Usual diagnostic criteria, including presenting symptoms, primary tumor, and other demographic characteristics, did

2007 Annals of Surgical Oncology

3796. Hypertensive crisis in a patient undergoing percutaneous radiofrequency ablation of an adrenal mass under general anesthesia. (Abstract)

Hypertensive crisis in a patient undergoing percutaneous radiofrequency ablation of an adrenal mass under general anesthesia. Radiofrequency ablation (RFA) is an effective therapeutic intervention for a variety of neoplastic lesions. Many of these procedures are conducted with patients under general anesthesia. Although RFA is associated with infrequent complications, it is not without risk. Injury to adjacent normal structures is a major concern during RFA of cancerous lesions. Unintended (...) injury to normal adrenal tissue during RFA of adrenal tumors can lead to hypertensive crisis, a potentially catastrophic complication. Hemodynamic consequences of RFA of primary or metastatic adrenal masses have not been reported. We report a case of hypertensive crisis (249/140 mm Hg), tachycardia, and ventricular arrhythmia in an 82-yr-old woman undergoing RFA of renal cell carcinoma metastatic to the adrenal gland. Anesthesiologists should be aware of this potentially catastrophic complication

2004 Anesthesia and Analgesia

3797. Imaging evaluation of the non-functioning indeterminate adrenal mass. (Abstract)

Imaging evaluation of the non-functioning indeterminate adrenal mass. With the increasing use of abdominal cross-sectional imaging in the investigation of patient symptoms and in cancer staging, incidental adrenal masses are frequently detected. The most common clinical question is whether these masses are benign or malignant. Benign adrenal masses such as myelolipomas, lipid-rich adenomas, adrenal cysts and adrenal haemorrhage have pathognomonic imaging findings. However, there remains (...) a significant overlap between the imaging appearances of some lipid-poor adenomas and malignant lesions, particularly metastases and small adrenal carcinomas. Our review looks at the recent advances in computed tomography, magnetic resonance imaging and positron emission tomography, which can be used to assist in the distinction between benign adenomas and malignant lesions of the adrenal gland.

2004 Trends in Endocrinology and Metabolism

3798. The clinically inapparent adrenal mass: update in diagnosis and management. Full Text available with Trip Pro

The clinically inapparent adrenal mass: update in diagnosis and management. Clinically inapparent adrenal masses are incidentally detected after imaging studies conducted for reasons other than the evaluation of the adrenal glands. They have frequently been referred to as adrenal incidentalomas. In preparation for a National Institutes of Health State-of-the-Science Conference on this topic, extensive literature research, including Medline, BIOSIS, and Embase between 1966 and July 2002, as well

2004 Endocrine Reviews

3799. Newborn screening for congenital adrenal hyperplasia: additional steroid profile using liquid chromatography-tandem mass spectrometry. Full Text available with Trip Pro

Newborn screening for congenital adrenal hyperplasia: additional steroid profile using liquid chromatography-tandem mass spectrometry. Neonatal screening programs for congenital adrenal hyperplasia (21-CAH) using an immunoassay for 17alpha-hydroxyprogesterone (17-OHP) generate a high rate of positive results attributable to physiological reasons and to cross-reactions with steroids other than 17alpha-OHP, especially in preterm neonates and in critically ill newborns.To increase the specificity (...) of the screening process, we applied a liquid chromatography-tandem mass spectrometry method quantifying 17alpha-OHP, 11-deoxycortisol, 21-deoxycortisol, cortisol, and androstenedione. The steroids were eluted in aqueous solution containing d8-17alpha-OHP and d2-cortisol and quantified in multiple reaction mode.Detection limit was below 1 nmol/liter, and recovery ranged from 64% (androstenedione) to 83% (cortisol). Linearity was proven within a range of 5-100 nmol/liter (cortisol, 12.5-200 nmol/liter

2007 Journal of Clinical Endocrinology and Metabolism

3800. Steroid profiling by tandem mass spectrometry improves the positive predictive value of newborn screening for congenital adrenal hyperplasia. Full Text available with Trip Pro

Steroid profiling by tandem mass spectrometry improves the positive predictive value of newborn screening for congenital adrenal hyperplasia. Congenital adrenal hyperplasia (CAH) is primarily caused by 21-hydroxylase deficiency and leads to an accumulation of 17-hydroxyprogesterone and reduced cortisol levels. Newborn screening for CAH is traditionally based on measuring 17-hydroxyprogesterone by different immunoassays. Despite attempts to adjust cutoff levels for birth weight, gestational age (...) , and stress factors, the positive predictive value for CAH screening remains less than 1%. To improve this situation, we developed a method using liquid chromatography-tandem mass spectrometry to measure 17-hydroxyprogesterone, androstenedione, and cortisol simultaneously in blood spots. A total of 1222 leftover blood spots from six different screening programs using different immunoassays (fluorescent immunoassay and ELISA) were reanalyzed in a blinded fashion by liquid chromatography-tandem mass

2004 Journal of Clinical Endocrinology and Metabolism

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